acyclovir and Lung-Diseases--Interstitial

Topics: Acyclovir; Antiviral Agents; Graft Rejection; Herpesvirus 6, Human; Herpesvirus 7, Human; Humans; Immunocompromised Host; Lung Diseases, Interstitial; Opportunistic Infections; Roseolovirus Infections; Transplantation

Cytomegalovirus is major infectious pathogen following allogeneic bone marrow transplantation. In infected recipients, the virus is generally detected between 4 and 10 weeks after transplantation. Historically, CMV disease developed in 30-40% of seropositive recipients, the predominante manifestation being interstitial pneumonitis, which was generally lethal. Therapeutic interventions are discussed with special reference to the use of antiviral therapy for both treatment and prevention of CMV disease. The strategies developed in the bone marrow transplantation population to treat or prevent the development of CMV disease can be extrapolated to other patients groups who are immunosuppressed and at risk for developing clinical manifestations of CMV infection.

Topics: Acyclovir; Bone Marrow Transplantation; Cytomegalovirus Infections; Ganciclovir; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Lung Diseases, Interstitial; Pneumonia, Viral

The prevention of cytomegalovirus (CMV) infection in individuals at the highest risk, such as CMV-seronegative recipients of allogeneic bone marrow transplants or of CMV-positive solid organ transplants, involves the use of blood products obtained from CMV-seronegative donors or the use of filtered blood products. In addition, the use of ganciclovir is becoming increasingly important as an early means of preventing serious disease. The options for use of ganciclovir include conventional prophylaxis early after engraftment or preemptive use after documented infection. Evidence is reviewed for selected use of this drug in only the highest-risk subjects to avoid unnecessary adverse effects. The optimal use of ganciclovir in specific patient groups needs to be evaluated, and general recommendations that fit all groups cannot be made at this time. Although the use of intravenous immunoglobulin (IVIG) in transplantation remains controversial, there is increasing evidence to support a recommendation of the use of IVIG as general support for the allogeneic bone marrow transplant recipient and of CMV antibody-enriched immunoglobulin in selected renal transplant recipients. For the treatment of CMV-associated pneumonitis, it is recommended that ganciclovir and IVIG be used in combination for the bone marrow transplant recipient and that ganciclovir be used with or without IVIG in patients in other transplantation groups.

Topics: Acyclovir; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Humans; Immunoglobulins, Intravenous; Lung Diseases, Interstitial; Organ Transplantation; Pneumonia; Transplantation

Lymphocytic interstitial pneumonitis (LIP) in children has been most commonly associated with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) associated LIP without HIV infection has been reported only in adults. EBV associated LIP has been reported in children, but only with concurrent HIV infection. We report a case of EBV associated, HIV negative LIP in a child.

Topics: Acyclovir; Antiviral Agents; Child; Epstein-Barr Virus Infections; Fever; Glucocorticoids; HIV Seronegativity; Humans; Lung; Lung Diseases, Interstitial; Lymphocyte Count; Male; Methylprednisolone; Reed-Sternberg Cells; Treatment Outcome

Topics: Acyclovir; Adult; Age of Onset; Antiviral Agents; Bone Marrow Transplantation; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lung Diseases, Interstitial; Male; Pneumonia, Viral

Recognition of cutaneous herpes simplex virus (HSV) in acquired immunodeficiency syndrome (AIDS) can be difficult because of its atypical prsentations. Pneumonia in AIDS is complex with many possible etiologies. Identification of HSV preceded by atypical cutaneous manifestation and pneumonia is critical, given the poor prognosis when treatment is delayed or not prescribed. We report a 62-year-old patient with undiagnosed HIV infection who presented with disseminated cutaneous lesions resembling impetigo as his first presentation of AIDS. Subsequent confirmation that HSV was responsible led to appropriate treatment of this and the complicating HSV pneumonia. This report emphasizes the importance of the early recognition of atypical cutaneous HSV in patients with AIDS.

Topics: Acyclovir; Antiviral Agents; Diagnosis, Differential; Herpes Simplex; HIV Seropositivity; Humans; Lung Diseases, Interstitial; Male; Middle Aged